| NPI | 1952796252 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 63054) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MN 63054) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-07-08 |