| NPI | 1245658962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME150879) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: KY TP028) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME150879) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 35.150118) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2024-07-24 |