| NPI | 1720094147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.078420) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 39052) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-09-18 |