| NPI | 1457364952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 34006575) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34006575) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-09 |