| NPI | 1699986984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35088885) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 104960) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 53255) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2011-06-27 |