| NPI | 1831325307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35124276) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 75604) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2025-10-17 |