| NPI | 1366402273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269048) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.074221) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME130248) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2019-12-05 |