| NPI | 1932594389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101271250) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 67216) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 66286-20) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-12-03 |