| NPI | 1568514289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 49464) |
| Additional Taxonomies | 2085N0700X (Licence: MD D65354) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.083810) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301093331) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2022-09-09 |