| NPI | 1104483973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: OH 35.141058) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.141058) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.141058) | |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-04-29 |