| NPI | 1881831436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 57251) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.009842) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 82545) | |
| Enumeration Date | 2009-01-18 |
| Last Update Date | 2022-07-14 |