| NPI | 1023338282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 66608) |
| Additional Taxonomies | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: SC MMD.32739.MD) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2017-00828) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2021-07-19 |