| NPI | 1043830797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: MN 79330) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351046328) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2025-05-07 |