| NPI | 1801279112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S4562) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.025757) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2020-06-27 |