| NPI | 1629117890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 46718) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 24357) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 11109) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2022-03-29 |