| NPI | 1912525254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.143104) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A168586) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2021-08-19 |