| NPI | 1588196182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.135857) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 58134) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.135857) | |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2023-11-08 |