| NPI | 1083140040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TN MD0000062429) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AL 44246) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-11-17 |