| NPI | 1760976955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.147805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301115998) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351043767) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-06-28 |