| NPI | 1174507446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35 081623) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: OH 35 081623) |
| 2085N0700X Radiology, Neuroradiology (Licence: OH 35 081623) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35 081623) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35 081623) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2012-11-15 |