| NPI | 1982067294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.134129) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A171252) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2026-03-05 |