| NPI | 1902399710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 58030691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 010066) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2019-06-23 |