| NPI | 1710172960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 50538) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 11235) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 52854-20) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2026-03-27 |