| NPI | 1801165824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55648) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.019789) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 106419) | |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2021-06-09 |