| NPI | 1992778922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 48526) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35091828) |
| 208D00000X General Practice (Licence: VA 0101238547) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2026-06-09 |