| NPI | 1649432022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 56921) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 70775) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 107020) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2013-09-27 |