| NPI | 1831189935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35077834) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 34427) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GU MC-212) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2024-03-25 |