| NPI | 1316108731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 68653) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME129347) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2024-04-12 |