| NPI | 1164744819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 262803) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-126846) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 46717) | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2020-12-17 |