| NPI | 1477642536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 63814) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME103995) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL TRN7847) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-18 |