| NPI | 1417576265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 81656) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2025001691) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 23929) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 86938-20) | |
| Enumeration Date | 2020-04-12 |
| Last Update Date | 2026-07-09 |