| NPI | 1730685405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101289331) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2026036120) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35C.004461) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35C.004461) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 43-53621) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0072416) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2026-08-17 |