| NPI | 1689673899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 19217) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 19217) |
| 208D00000X General Practice (Licence: OH 35.030273) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2017-03-13 |