| NPI | 1134119902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0059664) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 42076) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME98706) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2007-01488) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 89587) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 41021) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2013-04-02 |