| NPI | 1043470776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 51260) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 103915) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2020-08-20 |