| NPI | 1811169113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME116328) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD446438) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.093469) | |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2018-06-13 |