| NPI | 1780664268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 30868) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 47774) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MN 30868) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2023-01-06 |