| NPI | 1396791240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 49366) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 27656) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME0090817) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2011-12-15 |