| NPI | 1124108261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-097584) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 1842-850) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2015-12-30 |