| NPI | 1013124924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME159442) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57010313) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-03-07 |