| NPI | 1154427698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301078438) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35-088321) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2019-08-22 |