| NPI | 1558571323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 89342) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: OH 35089342) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2016-06-24 |