| NPI | 1134810856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 80423) |
| Additional Taxonomies | 2085N0904X (Licence: MN 34055) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 33283) | |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2025-07-10 |