| NPI | 1457477358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.095027) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 50483) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301086310) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2023-09-01 |