| NPI | 1710118302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.128186) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 80000009) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2018-01-26 |