| NPI | 1144204827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 28223) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 31918) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 23110) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2020-09-18 |