| NPI | 1063611531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A119427) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301090470) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2021-12-15 |