| NPI | 1578543401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 53793) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 47965) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2023-10-31 |