| NPI | 1770504318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35079797D) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 246971) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2026-06-16 |