| NPI | 1013972967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME0071728) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35065626) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2007-11-07 |