| NPI | 1063919314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 76472) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 83844) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2024-07-22 |