| NPI | 1629048319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 38007) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 17304) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35080888) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 265500) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME64815) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036133592) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2017-02-08 |