| NPI | 1932416401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N4340) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 106225) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55576) | |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2021-06-02 |