| NPI | 1003024159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-16256) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.093583) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.093583) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2023-04-03 |