| NPI | 1417984097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 175198) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.140765) |
| 2085R0205X Radiology, Radiological Physics (Licence: NY 175198) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2021-03-23 |