| NPI | 1588912711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.141140) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY P84475) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2021-04-12 |