| NPI | 1477535680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD11717) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R0330) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.137408) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2017-00850) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2026-04-23 |