| NPI | 1811376254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 4384) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 58.031326) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2021-07-20 |