| NPI | 1427416312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61225041) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 68838) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2024-01-16 |