| NPI | 1699715300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35-07-0141) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WV 20136) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WV 20136) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 35-070141) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2020-12-04 |