| NPI | 1023645199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: OH 35.144179) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: OH 35.144179) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.144179) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-07-07 |