| NPI | 1225015969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 19079) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 33661) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35080661S) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2010-01-08 |