| NPI | 1801816814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 29818) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME58872) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.132265) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-08-04 |