| NPI | 1790879575 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 51689) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: OH 35.088582) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-03-02 |