| NPI | 1861682643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 25797) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.094798) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2021-04-01 |