| NPI | 1750356291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-066640) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301051031) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 40516) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2026-04-16 |