| NPI | 1881838456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101259857) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57-014651) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57-014651) | |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2022-11-29 |