| NPI | 1104516590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 77835) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 33506) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2024-08-26 |