| NPI | 1003435967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 81780) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.018252) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2026-07-01 |