| NPI | 1518183284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR DO218394) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34011489) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101016089) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2024-03-19 |