| NPI | 1255591996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 62262) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 107009) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 56877) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2019-05-29 |