| NPI | 1033439492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.128174) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 37954) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GU MC-209) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2024-03-25 |