| NPI | 1235111279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 36672) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 36672) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.094777) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2024-06-13 |