| NPI | 1093771628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35086064) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 40508) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R1087) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD440045) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2023-09-05 |