| NPI | 1003089772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2013005685) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: OH 35-123042) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2016-03-07 |