| NPI | 1629078753 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 36806) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MN 36806) |
| 2085B0100X Radiology, Body Imaging (Licence: MN 36806) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2009-03-03 |