| NPI | 1891952099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 57070) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.087156) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD443431) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2022-05-19 |