| NPI | 1417029455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.008149) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2007-00979) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2019-06-20 |