| NPI | 1063410421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD24573) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00042413) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M0739) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 0053167) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 31555) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 38341) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-077845) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD25383) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2021-04-23 |