| NPI | 1902999170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 34 001814) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: OH 1814) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-05-22 |