| NPI | 1407116718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.146771) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101267361) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101267361) | |
| 208D00000X General Practice (Licence: NY 2756654) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2023-01-17 |