| NPI | 1942401013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0011028) |
| Additional Taxonomies | 2085N0700X (Licence: DE C1-0011028) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DE C1-0011028) | |
| 2085N0700X (Licence: MN 54602) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 54602) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2025-09-23 |