| NPI | 1245443746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 34.010424) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 58-002217) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5101019053) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2013-05-08 |