| NPI | 1801174552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 54363) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 105572) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2012-02-03 |