| NPI | 1205080744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55113) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 51373020) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2021-07-19 |