| NPI | 1710287230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD454383) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD454383) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 128746) | |
| Enumeration Date | 2010-10-31 |
| Last Update Date | 2021-07-27 |