| NPI | 1669001061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 81733) |
| Additional Taxonomies | 2085N0700X (Licence: MN 81733) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2026-07-07 |