| NPI | 1255502498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 58600) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ND PT11915) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 134127) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ND 11915) | |
| Enumeration Date | 2008-03-16 |
| Last Update Date | 2018-09-19 |