| NPI | 1215378872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.123901) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301102485) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2020-12-18 |