| NPI | 1053365437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 15389) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 48477) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2017-10-20 |