| NPI | 1962401182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34-004758) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101015199) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34 004758S) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2011-08-31 |