| NPI | 1780685404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 47740) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MN 47740) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 64033) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MN 47740) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2020-09-14 |