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 |