| NPI | 1679754675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 66674) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35082795) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35-082795) | |
| Enumeration Date | 2007-11-18 |
| Last Update Date | 2019-10-30 |