| NPI | 1285639690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-048137) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-1946) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2017-12-14 |