| NPI | 1427231638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.092843) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M7874) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2010-0147) | |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2010-09-28 |