| NPI | 1770531204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NM MD2009-0544) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 40744) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.089451) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 234069) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-10-18 |