| NPI | 1205942711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 201785) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301118778) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.136333) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01062697A) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2019-08-12 |