| NPI | 1578675138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 48915) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 102497) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-14 |