| NPI | 1811976863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 45664) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 4224) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2020-07-09 |