| NPI | 1093000747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 70711) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC MD34530) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-03-29 |