| NPI | 1619159647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 35.123266) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AK 234334) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2025-05-05 |