| NPI | 1790734002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 09305) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-036013 Y) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 36115272) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2007-11-19 |