| NPI | 1265422604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35067531) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G68151) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K7535) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2024-04-02 |