| NPI | 1518257898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0102204396) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102204396) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 34.013820) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2024-02-05 |