| NPI | 1831139138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34-00-5682) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 1416) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2020-11-06 |