| NPI | 1073709531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301083869) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD443256) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57012650) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD443256) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2021-07-09 |