| NPI | 1164575411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 47400) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME 98928) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2021-07-12 |