| NPI | 1588656763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 36873) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MN 36873) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MN 36873) | |
| 2085N0700X Radiology, Neuroradiology (Licence: MN 36873) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: MN 36873) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2009-03-03 |