| NPI | 1477843720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55612) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 106305) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2013-08-29 |