| NPI | 1760747794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34C.000673) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 3399) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 77863) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2026-06-05 |