| NPI | 1487064945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 05-43007) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020012515) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.013873) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2025-03-07 |