| NPI | 1952509630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35099232) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 45560) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2026-07-31 |