| NPI | 1285611004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 18082) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-08-0594-K) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 31771) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 31771) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2023-06-09 |