| NPI | 1639161847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: KS 04-33832) |
| Additional Taxonomies | 2085N0700X (Licence: MI 4301072396) |
| 2085N0700X (Licence: NE 26108) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-33832) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301072396) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME149643) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1016923) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2025-02-24 |