| NPI | 1265717656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.122872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57020052) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2019-10-15 |