| NPI | 1801214994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.131709) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 70939) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2020-08-13 |