| NPI | 1083652838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35066128) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.066128) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY 44804) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2023-08-30 |