| NPI | 1720615164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 81254) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 23123) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 60450) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.143067) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 86910-20) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-06-30 |