| NPI | 1750506481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35122959) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 20439) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2016-08-08 |