| NPI | 1205859717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.093152) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MN 102537) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 102537) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-01-05 |