| NPI | 1407084478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 74857-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 53947) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2012011152) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2021-08-25 |