| NPI | 1740501329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 127871) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2011012271) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 49431) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2016-11-11 |