| NPI | 1972777589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 34009515) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GU DOC-034) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2024-03-25 |