| NPI | 1639389133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 11765) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 14725R) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 60041527) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.094848) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2012-11-13 |