| NPI | 1225297021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.144688) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A109747) |
| 208D00000X General Practice (Licence: CA A109747) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2024-08-05 |