| NPI | 1912935545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.058819) |
| Additional Taxonomies | 2471B0102X Radiologic Technologist, Bone Densitometry |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-07-14 |