| NPI | 1689884587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.095572) |
| Additional Taxonomies | 2085N0904X (Licence: OH 35.095572) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2026-03-10 |