| NPI | 1710068952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G80763) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301057569) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.142301) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2023-03-21 |