| NPI | 1083662803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WI 43077) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35088854) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2016-06-24 |