| NPI | 1043607013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 30298) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.140905) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY IP1498) | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2021-07-15 |