| NPI | 1104211309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.141235) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 281871) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2024-06-05 |