| NPI | 1376509851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35091256) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301048682) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301048682) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2018-01-09 |