| NPI | 1316965528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 31028) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35031028) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-05-12 |