| NPI | 1609068535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME137720) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-01253) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.093800) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2024-01-08 |