| NPI | 1528389004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 63258) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-04825) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34011436) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2018-03-30 |