| NPI | 1568589083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 61677) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 51898-20) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2021-07-12 |