| NPI | 1184186124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.153394) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 281343) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-05-16 |