| NPI | 1538458732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.129167) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA 139696) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NV 18204) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2024-06-05 |