| NPI | 1164401535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR 170867) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 47145) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 25.000136) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2017-02-08 |