| NPI | 1265895494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 60956999) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 75930) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 20771) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 83068-20) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2025-09-03 |