| NPI | 1811192875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.092107) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 045251) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2011-08-19 |