| NPI | 1124588561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 34.017009) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY TP522) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2025-08-26 |