| NPI | 1699709212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 25.000128) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 9774) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60074874) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-14339) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-10-26 |