| NPI | 1801115159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 11015755) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.016826) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-41802) | |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2015-08-17 |