| NPI | 1134395858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.096082) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 57.012433) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2021-07-14 |