| NPI | 1952431074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 14227359-1235) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.088021) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY 40883) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2025-08-28 |