| NPI | 1861734592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDRH.0067246) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102208244) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.013624) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2023-12-05 |