| NPI | 1053639740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60743960) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60743960) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301108918) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2024-02-21 |