| NPI | 1609052000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 71179) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA C136738) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35097777) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX P4768) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: LA MD.201955) | |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2022-04-12 |