| NPI | 1992191894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 73272) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 60730) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2021-06-28 |