| NPI | 1104052430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD442575) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301116476) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 51954) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.135910) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.135910) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD442575) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 51954) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301116476) | |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2019-08-12 |