| NPI | 1073813812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.012225) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 13965) |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2020-09-17 |