| NPI | 1407268741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: DC MD210002280) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: OH 35.129311) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2023-02-20 |