| NPI | 1578713517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35125124) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: OH 35125124) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35125124) | |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2022-05-19 |