| NPI | 1114157369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63652) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 58856) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2020-09-14 |