| NPI | 1114199197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35123344) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 249788) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 30836) | |
| Enumeration Date | 2008-03-30 |
| Last Update Date | 2014-05-27 |