| NPI | 1053748822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.013120) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU DOC-033) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 34.013120) | |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2023-11-30 |