| NPI | 1992202618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 238801) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.138913) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 9218) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101282536) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 101380) | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-09-20 |