| NPI | 1912981697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 13967) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 31603) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35080601S) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2010-01-08 |