| NPI | 1588624993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301073012) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101044078) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.084863) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2023-12-15 |