| NPI | 1497998801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 35120611) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2009007643) |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2013-06-28 |