| NPI | 1659866697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.147717) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2026-01995) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0106524) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 58105) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 36551) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101288818) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2026-06-23 |