| NPI | 1023265386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: OH 35.123357) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: OH 57.022413) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.123357) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2014-06-30 |