| NPI | 1154536696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 51063) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 103736) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 23701) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-03-14 |