| NPI | 1184601908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 21514) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-085169) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 39150) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-05-07 |