| NPI | 1841263803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 34820) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34007830) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 60329) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-06-14 |