| NPI | 1578844379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 59395) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: OH 57.019104) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2020-08-13 |