| NPI | 1962555920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 50605) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 18516) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2023-12-21 |