| NPI | 1205090917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.120906) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301092934) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2014-00570) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.120906) | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2018-07-11 |