| NPI | 1477509644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101051681) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301076457) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.123144) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD044643E) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2018-02-08 |