| NPI | 1902253883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.144822) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.029) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2022-08-04 |