| NPI | 1225590219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 102972) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 34.014967) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: OH 34.014967) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2026-05-07 |