| NPI | 1790764884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 01013) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35085785) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: NC 01013) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2010-04-08 |