| NPI | 1063532778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A91921) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA A91921) |
| 2085N0700X Radiology, Neuroradiology (Licence: CA 893219) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A91921) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 893219) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2021-01-11 |