| NPI | 1912388869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 59789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 59789) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2019-01-18 |