| NPI | 1861485740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35072581) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: OH 35072581) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2020-08-13 |