| NPI | 1508065632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 48722) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35-095672) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 59044) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2020-09-10 |