| NPI | 1821385485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: OH 35.130542) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MI 4301098671) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301098671) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2018-03-17 |