| NPI | 1922569946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.152686) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 91141) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2025-05-07 |