| NPI | 1023019759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 101866) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 101866) |
| 2085B0100X Radiology Body Imaging (Licence: MN 101866) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2009-03-03 |