| NPI | 1417211483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 56567) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 68648-20) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2021-07-06 |