| NPI | 1386445658 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 83051) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 35163) |
| Enumeration Date | 2025-03-22 |
| Last Update Date | 2026-07-14 |