| NPI | 1275710295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.135123) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R4586) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60030884) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 026445) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME138428) | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2023-07-31 |