| NPI | 1063669554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35126135) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125052455) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35126135) | |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2021-09-28 |