| NPI | 1083689483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 36506) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: MN 36506) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 23640) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2020-08-13 |