| NPI | 1568615623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 57371) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 35.123715) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 57.016976) | |
| 208D00000X General Practice (Licence: WI 52326-20) | |
| Enumeration Date | 2008-11-02 |
| Last Update Date | 2020-09-09 |