| NPI | 1518304930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 71794) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 31587) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 2102) | |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2022-12-12 |