| NPI | 1891795324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 202520) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD070978L) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.079795) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2022-04-06 |