| NPI | 1811300932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.146539) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101276635) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A-142642) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2025-03-04 |