| NPI | 1255422606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.088516) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2177) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2019-10-29 |