| NPI | 1427060334 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65451) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 45449) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2019-08-01 |