| NPI | 1356736482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 60849) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 15222) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2024-04-15 |