| NPI | 1861745770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 03981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.00485) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2021-12-16 |