| NPI | 1851373120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35043927E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.043927) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2018-06-18 |