| NPI | 1952388548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 31922) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 31922) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-078227-H) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 19783) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2020-10-18 |