| NPI | 1689969164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: OH 35.143378) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: MA 278736) |
| 2085P0229X Radiology Pediatric Radiology (Licence: MA 2766479) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2021-10-04 |