| NPI | 1760943229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0077602) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 34.017090) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5151014546) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2026-08-03 |