| NPI | 1164656559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2019042401) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 52155) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35125154) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 47753) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301095035) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01074617A) | |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2020-08-18 |