| NPI | 1801861620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.078236) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-07-8236-H) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2021-09-28 |