| NPI | 1558697599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34009768) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 4478) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 58.003040) | |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2020-12-21 |