| NPI | 1053374462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 70639) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MN 70639) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 21727) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0062827) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2022-11-29 |