| NPI | 1467761130 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 56849) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101017750) |
| 2085N0700X Radiology, Neuroradiology (Licence: MN 106949) | |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2014-08-12 |