| NPI | 1023284809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A103448) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35-099567) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101257381) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2016-05-06 |