| NPI | 1275742629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35095538) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301083683) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2009-00763) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-12-09 |