| NPI | 1548285851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 01074533A) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WV 22235) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.081973) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: KY 42514) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-01-23 |