| NPI | 1275522435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OH 35081704) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35081704) |
| 2085R0001X (Licence: OR MD214545) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2026-08-21 |