| NPI | 1972858652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 56996) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 24990) |
| 208600000X Surgery (Licence: ND TRL 12380) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2018-04-05 |