| NPI | 1760642946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.150279) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 59008) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2024-09-23 |