| NPI | 1902035066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R1219) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 250552) |
| 2085N0700X Radiology, Neuroradiology (Licence: OH 35.136058) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.136058) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2024-06-05 |