| NPI | 1891775268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: VA 0101224776) |
| Additional Taxonomies | 2085N0700X (Licence: AR E-18165) |
| 2085N0700X (Licence: OH 35-098956) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-18165) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-098956) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ND 22211) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2025-05-27 |