| NPI | 1154677375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 57141) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 107042) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2020-09-29 |