| NPI | 1669494852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34-00-7661-C) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 334205) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2026-06-22 |