| NPI | 1396918017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21427) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 769-L) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57.011402) | |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2021-09-09 |