| NPI | 1073590790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 73197) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 32986) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-081267D) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 18967) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-03-24 |