| NPI | 1760608178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 58540) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 50086) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 23287) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2021-07-08 |