| NPI | 1568858033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A172931) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020012220) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.138560) | |
| Enumeration Date | 2015-04-11 |
| Last Update Date | 2022-05-26 |