| NPI | 1457552135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.099665) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.099665) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57011769) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.099665) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-04-12 |