| NPI | 1912403890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.148068) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.073520) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2024-05-31 |