| NPI | 1225035264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 54043) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MA 54043) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 3585828) | |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2017-12-12 |