| NPI | 1063624864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35085136) |
| Additional Taxonomies | 2085N0700X (Licence: OH 35085136) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35085136) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35085136) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2025-04-25 |