| NPI | 1487736070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2009-01436) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN PY52482) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 33569) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2017-12-20 |