| NPI | 1316906894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G77083) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA G77083) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 25000064) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: OH 25000064) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2012-03-21 |