| NPI | 1447677570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 59677) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2014019436) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2015-10-12 |