| NPI | 1245423045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD445309) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 25.000249) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 48875) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2017-03-24 |