| NPI | 1548643315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 73542) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN Res Permit 24737) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2021-07-15 |