| NPI | 1861620601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.098172) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: AZ 45331) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX P8206) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0050478) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME130339) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2019-05-21 |