| NPI | 1629338645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 330150) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301102517) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.139292) | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2022-07-11 |