| NPI | 1215058110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 001196) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0058928) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.094883) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2022-07-21 |