| NPI | 1417480732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 78911) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35C.004071) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 14485-320) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 56160) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 23175) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2026-05-04 |