| NPI | 1881655504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WV 22747) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: KY 41331) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WV 22747) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 41331) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 35.089968) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-10-18 |