| NPI | 1316144710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME147582) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35121718) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.121718) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-03-22 |