| NPI | 1124009931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35089595) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 216373) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2014-07-18 |