| NPI | 1871752428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036-132985) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.123822) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 82252) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.123822) | |
| Enumeration Date | 2008-06-07 |
| Last Update Date | 2023-10-13 |