| NPI | 1285830141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: OH 35.089893) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35 089893) |
| 2085P0229X Radiology Pediatric Radiology (Licence: KY 42451) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2023-09-20 |