| NPI | 1063535995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WI 52594) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60500535) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WI 52594020) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WA MD60500535) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2023-11-02 |