| NPI | 1477547305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.140341) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: PA MD-026080-E) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2024-06-06 |