| NPI | 1134653702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 291058) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.013483) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2024-02-01 |