| NPI | 1518279660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.098210) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM TM2016-0479) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 52676) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 51679) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2021-11-22 |