| NPI | 1720518061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.017731) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS19541) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5315086094) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-05-20 |