| NPI | 1114126588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2010-00215) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57.011728) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD26065) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2023-08-15 |