| NPI | 1629096201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34002340M) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 34524) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 733) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2013-03-26 |