| NPI | 1194189605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 71019) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS20364) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI DO01162) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2024-01-08 |