| NPI | 1023178159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35093872) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2001004973) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IL 36116990) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2011-08-19 |