| NPI | 1356329783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID M-12609) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35-067004) |
| 208D00000X General Practice (Licence: IL 036.127977) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2015-05-08 |