| NPI | 1417164880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.093235) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 01061639A) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 35.093235) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2024-01-09 |