| NPI | 1811109143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 229391) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25ma08531700) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI md12834) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA 435786) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 092604) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 42149) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 23262) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01066297A) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2009-04-06 |