| NPI | 1851416325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.099409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.012235) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2013-11-12 |