| NPI | 1225021413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.069504) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME102229) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01050837A) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.202356) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2021-06-22 |