| NPI | 1790976462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 78132) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A120380) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CO 52347) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0052347) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120380) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 4930) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2025-03-04 |