| NPI | 1548247273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 10783) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 31500) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35081139A) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2007-07-08 |