| NPI | 1689888422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.144215) |
| Additional Taxonomies | 2085N0700X (Licence: OH 35.144215) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2026-05-28 |