| NPI | 1356607725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 71855) |
| Additional Taxonomies | 2085N0700X (Licence: MN 71855) |
| 2085N0700X (Licence: OR MD188721) | |
| 2085N0700X (Licence: WA MD60839357) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60839357) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD188721) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2023-01-03 |