| NPI | 1598883530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101244031) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101244031) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.138128) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2021-10-28 |