| NPI | 1518300870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 68152) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0054893) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 76083) | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2022-09-26 |