| NPI | 1962489104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35C.001696) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K0927) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2026-03-05 |