| NPI | 1770520330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-06-2892) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 18423) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 18423) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.062892) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2021-01-21 |