| NPI | 1023173143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.093784) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD434013) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.093784) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2015-09-16 |