| NPI | 1235406851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57.019682) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.019682) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2018-02-21 |