| NPI | 1073941936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2018-00127) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.005263) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5101024642) | |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2024-01-31 |