| NPI | 1205819125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34004205W) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 34-004205) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2016-01-14 |