| NPI | 1063530277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35 125930) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 48745) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35 125930) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2023-10-30 |