| NPI | 1669466462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME46901) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D76130) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 25.000270) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2016-03-15 |