| NPI | 1740643717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 78601) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-00366) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 75008) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 69011) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 109513) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 95683) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2026-05-27 |