| NPI | 1114246113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 57701) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 57701) |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2021-07-07 |