| NPI | 1275634628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN MN29671) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MN MN29671) |
| 2085B0100X Radiology, Body Imaging (Licence: MN MN29671) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2011-07-25 |