| NPI | 1275551160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 54055) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-06-8549) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301116279) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-12-12 |