| NPI | 1164657896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301105438) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.129028) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI L254502) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2025-08-05 |