| NPI | 1841253986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 76344) |
| Additional Taxonomies | 2085N0700X (Licence: CO 46161) |
| 2085N0700X (Licence: MN 76344) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 46161) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2024-09-05 |