| NPI | 1760412167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2019033514) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-08-3106) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2022-09-12 |