| NPI | 1194010561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 33786) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 49254) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.150869) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2024-10-09 |