| NPI | 1942620968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 70046) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 85792) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2021-08-20 |