| NPI | 1134654908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 74176) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 71863-20) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2023-07-31 |