| NPI | 1629401187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35139457) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.026597) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57.026597) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2020-06-11 |