| NPI | 1144279035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME109555) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35086373) |
| 2085B0100X Radiology, Body Imaging (Licence: FL ME109555) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2015-04-03 |