| NPI | 1386649598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-083832) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 15407) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 227022) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD059744L) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 38772) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2022-04-08 |