Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 12095 | SD |
NPI | 1346669280 |
---|---|
Provider Name | Joshua Ryan |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Sioux Falls, SD 57104-4654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 25/08/2020 |