| NPI | 1619165842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A109534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57-013185) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2013-09-13 |