| NPI | 1811565633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MN 81868) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT223013) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351050276) | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2026-06-05 |