| NPI | 1023706587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 77550) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 34111) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2024-10-21 |