| NPI | 1336309053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2012-00525) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AL MD33400) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD15680) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: RI LP01317) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35120993) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2022-02-03 |