| NPI | 1114908159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 48546) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MN 48546) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2021-07-22 |