| NPI | 1609139070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 66503) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 66503) |
| 207R00000X Internal Medicine (Licence: IL 125060855) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-09-03 |