| NPI | 1629078720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: OH 82627) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WV 17797) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 17797) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 82627) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2010-12-07 |