| NPI | 1477538437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35074818) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 71260) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 30988) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2015-01-12 |