| NPI | 1215904594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.091036) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 38208) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 42587) | |
| Enumeration Date | 2006-03-04 |
| Last Update Date | 2013-06-24 |