| NPI | 1912253188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD465569) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57-020918) |
| 207UN0902X Nuclear Medicine Nuclear Imaging & Therapy (Licence: KY 55043) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2015038805) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2021-06-28 |