| NPI | 1992778922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35091828) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101238547) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2018-02-19 |