| NPI | 1568925402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.141765) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V1793) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2024-08-11 |