| NPI | 1508156043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.126314) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 0) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2018-03-17 |