| NPI | 1407856214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35050302) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: OH 35050302) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 51107) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-177) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2023-09-19 |