| NPI | 1659357804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MN 64006) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P3700) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 33420) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2025-01-08 |