| NPI | 1093761926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N8476) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35090286) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2023-11-02 |