Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jun 26, 2006
License(s)
01091583A (IN), MD 00047959 (WA), 225479 (NY), 01091583A (IN), 069366 (GA), 01091583A (IN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 714 N SENATE AVE STE 200 | Indianapolis, IN 46202-3297 | 317-963-0156 |
| MAILING | 1016 ISLAND BOULEVARD FI | Fox Island, WA 98333-9533 | 253-282-5331 |
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