| NPI | 1780046318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.145228) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A181756) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25IA12579400) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2025-08-20 |