| NPI | 1124207378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 44421) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57013908) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101247537) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2012-11-20 |