| NPI | 1578687919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 23112) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.091705) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-04-02 |