| NPI | 1700885142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35087482) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD421874) |
| 2085B0100X Radiology Body Imaging (Licence: OH 35 087482) | |
| 2085N0700X Radiology Neuroradiology (Licence: OH 35087482) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2012-02-15 |