| NPI | 1679066021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.148350) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 33901) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2024-06-27 |