| NPI | 1659622470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57.021284) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 75634) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2025-11-14 |