| NPI | 1811105182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 50494) |
| Additional Taxonomies | 2085N0700X (Licence: IA 39727) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 39727) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2011-08-17 |