| NPI | 1518233642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 63458) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301100504) |
| 207R00000X Internal Medicine (Licence: MI 4301100504) | |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2023-11-16 |