| NPI | 1811557606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.152546) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019018905) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2025-05-19 |