| NPI | 1659352359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301079013) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD038348) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G68078) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-084238) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2010-00441) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2013-03-26 |