| NPI | 1568652147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35098953) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 20530) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 41027) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301082426) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-194) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2024-04-26 |