| NPI | 1073773982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN 51272) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 51272) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101247567) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2024-03-20 |