| NPI | 1083819593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 55667) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.090765) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.090765) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2021-09-27 |