| NPI | 1881921062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 34.011251) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 1871) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2024-06-05 |