| NPI | 1568921807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V6074) |
| Additional Taxonomies | 2085R0001X (Licence: TX V6074) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.017143) | |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2025-05-13 |