| NPI | 1558414441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 43859) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-095539) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101245340) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2022-10-28 |