| NPI | 1114376332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CA A163187) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.157046) |
| 2085N0700X (Licence: PA MD454615) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2026-08-31 |