| NPI | 1730716523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 69809) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 31493) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2021-07-26 |