| NPI | 1104826916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 47326) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35081743) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2006002250) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2021-04-20 |