| NPI | 1063401016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 17036) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 308060) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35068243) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2022-09-08 |