| NPI | 1205273083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63695-20) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2021-07-12 |