| NPI | 1104273549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 62037) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 16161C) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GU MC-170) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 75151) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ND 20238) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2025-08-13 |