| NPI | 1609296730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WY TL6212) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: WY TL6212) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.147140) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2024-04-19 |