| NPI | 1053762088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 76191-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 62507) |
| 208D00000X General Practice (Licence: ND RL 14201) | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2023-02-10 |