| NPI | 1255529285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301090479) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.120939) |
| 2085N0700X Radiology, Neuroradiology (Licence: OH 35.120939) | |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2021-08-24 |