| NPI | 1124482765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 62893) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 21211) |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2022-09-26 |