| NPI | 1609097716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.009896) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101016046) |
| 2085N0700X Radiology, Neuroradiology (Licence: OH 34.009896) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 047911) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2019-07-10 |