| NPI | 1982682209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 64827) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00042409) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 12348) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2022-07-13 |