| NPI | 1760684898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.137753) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301088492) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT190192) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2023-09-14 |