| NPI | 1104446772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 82080) |
| Additional Taxonomies | 2085N0700X (Licence: WI 81796-21) |
| 2085N0700X (Licence: MN 82080) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 24207) | |
| 2085N0700X (Licence: ND 24207) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81796-21) | |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2026-07-07 |