| NPI | 1417185323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.127109) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301094954) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0053757) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2015-10-29 |