| NPI | 1306333109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65990) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 83777) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2025-04-10 |