| NPI | 1689885972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.092266) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.092266) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 42056) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 42056) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 21676) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-08-13 |