| NPI | 1407047038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C2-0008642) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD H65982) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34-009004) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2013-02-14 |