| NPI | 1053527408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35090809) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 33087) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 33087) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2014-04-15 |