| NPI | 1336253632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 37599) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI EMC0007015) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.140944) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 75187-20) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2026-03-30 |