| NPI | 1134651185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 79625) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022013463) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 17265) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22410) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 13545-320) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2025-10-29 |