| NPI | 1386641454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35072707K) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: OH 35072703) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2016-03-07 |