| NPI | 1669675658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 069708) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 099200) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2013-12-27 |