| NPI | 1225755317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-18524) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: AR E-18254) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: OH 57.253819) | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2025-02-05 |