| NPI | 1053639542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35098833) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N3137) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2014-05-23 |