| NPI | 1538420120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.011121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH AP2282058A13) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2019-09-12 |