| NPI | 1972580561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 21218) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 38317) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35-083289-C) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2024-05-06 |