| NPI | 1144261769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 34-00-2831) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 722) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2015-02-06 |