| NPI | 1326425174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 60721) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 75947) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2022-09-28 |