| NPI | 1831394402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 66605) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 35375) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-00128) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.092685) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2021-07-12 |