| NPI | 1780117762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 64609) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 77606) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2024-01-22 |