| NPI | 1861690836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-120945) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301090313) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D74002) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2015-12-30 |