| NPI | 1912394495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U6233) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10052972) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57.028708) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2024-05-16 |