| NPI | 1659868750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 33347) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 33347) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 49254) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.150869) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2024-10-09 |