| NPI | 1376845040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.125790) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.018179) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2021-12-27 |