| NPI | 1891080644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: OH 35.138071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10041501) |
| 2085N0700X Radiology, Neuroradiology (Licence: WA ML60662153) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2020-05-08 |