| NPI | 1770112948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 69679) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 29780) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2021-07-21 |