| NPI | 1518948777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101255993) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WV 25818) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-08-2609-N) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2007-00091) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2023-12-14 |