| NPI | 1396785424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-06-0247) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 16694) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2020-11-09 |