| NPI | 1629282306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 24791) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY TP353) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.099135) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2009-00703) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2012-05-29 |