| NPI | 1801329222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.140831) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 59902) |
| 207R00000X Internal Medicine (Licence: OH 57.247315) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 36529) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2026-07-20 |