| NPI | 1982822540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52857) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology (Licence: IA 37112) |
| 261QR0200X Clinic/Center, Radiology (Licence: NE 5217) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2021-01-07 |