| NPI | 1639167877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS11094) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 24.000017) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2017-04-10 |