| NPI | 1568783744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 49119) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.128554) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD453879) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2022-08-25 |