| NPI | 1700165453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 54351) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 105652) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2011-09-20 |