| NPI | 1184923732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WV 27481) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 50319) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35130893) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: KY 50319) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2024-05-13 |