| NPI | 1194764423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2016034203) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35093053) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35093053) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2016034203) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2016-10-11 |