| NPI | 1629292040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.086055) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX l8773) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 86055) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00049456) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-12-27 |