| NPI | 1396374344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 81650) |
| Additional Taxonomies | 2085N0700X (Licence: MN 81650) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 24106) | |
| 2085N0700X (Licence: WI 87153-20) | |
| 2085N0700X (Licence: ND 24106) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 87153-20) | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2026-07-07 |