| NPI | 1073564407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G70784) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA G70784) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G70784) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-06-09 |