| NPI | 1740775055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301511361) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.149255) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V0865) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2025-09-26 |