| NPI | 1821098872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 38328) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MN 38326) |
| 2085N0904X Radiology Nuclear Radiology (Licence: MN 38326) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 38326) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2019-03-21 |