| NPI | 1740220409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 74300) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 39666) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2024-03-28 |