| NPI | 1013256742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A165730) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD187166) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60837313) | |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2020-03-17 |