| NPI | 1033695937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.140156) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 54802) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: OH 57.245315) | |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2023-11-06 |