| NPI | 1013212869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.126611) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.018288) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY 50089) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.126611) | |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2023-11-08 |