| NPI | 1083691893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 16125) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 31524) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35-080583-D) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2010-01-08 |