| NPI | 1447241195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 34 04 5914) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: OH 34 04 5914) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 34 04 5914) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2011-01-05 |