| NPI | 1417361379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7236) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 11902) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 12742A) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-04-27 |