| NPI | 1003057274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A107314) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT183860) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A107314) | |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2023-01-13 |