| NPI | 1073616363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35C.003735) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G52508) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 181125) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35C.003735) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2026-03-18 |