| NPI | 1245439744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 57237) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 107240) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 82012) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-03-12 |