| NPI | 1235177015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 23536) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35044808M) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2012-12-04 |