| NPI | 1407982515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 63511) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101241122) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301091521) | |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2018-06-06 |