| NPI | 1851566269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OR MD206332) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.126824) |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2021-09-07 |