| NPI | 1558484519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301080490) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD d0065671) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 295098-1205) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID m-10409) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.096665) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2014-06-24 |