| NPI | 1366928616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35139189) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: OH 57.245150) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2020-05-20 |