| NPI | 1881057883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 71714) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 86983-20) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22451) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2026-07-07 |