| NPI | 1659365872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35079693) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 26307) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2023-06-19 |