| NPI | 1245408426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: OH 35.136826) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: MO 2010020722) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: KY 43585) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY 43585) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 43585) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 43585) | |
| 2085N0700X Radiology, Neuroradiology (Licence: KY 43585) | |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2019-09-19 |