| NPI | 1982689923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 301436) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: OH 35.077174) |
| 2085D0003X Radiology Diagnostic Neuroimaging (Licence: OH 35.077174) | |
| 2085N0700X Radiology Neuroradiology (Licence: OH 35.077174) | |
| 2085N0904X Radiology Nuclear Radiology (Licence: OH 35.077174) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: OH 35.077174) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2022-04-25 |