| NPI | 1609010677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME149726) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 16829) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: HI MD-22705-0) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.146149) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 48993) | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2022-12-09 |