| NPI | 1346796653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 62606) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 76233) |
| Enumeration Date | 2016-08-27 |
| Last Update Date | 2024-01-11 |