| NPI | 1457679391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CO DR.0063854) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 57.018182) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX Q4090) | |
| Enumeration Date | 2010-05-15 |
| Last Update Date | 2022-02-01 |