| NPI | 1396984159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 068199) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.132528) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.132528) | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2025-06-18 |