| NPI | 1295722858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 291931) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: NY 291931) |
| 207U00000X Nuclear Medicine (Licence: OH 35-07-5321-A) | |
| 208D00000X General Practice (Licence: OH 35-07-5321-A) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2018-01-29 |