| NPI | 1902919376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 55291) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 55448) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-07-12 |