| NPI | 1760470629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 72968) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IA 33274) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 33274) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2023-02-10 |