| NPI | 1255698221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 66995-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 63777) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2020-11-03 |