| NPI | 1831623057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.148512) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.148512) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MT225458) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2023-07-26 |