| NPI | 1821253675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD433915) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: PA MD433915) |
| 2085B0100X Radiology Body Imaging (Licence: OH 81.000088-MD) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2016-08-12 |