| NPI | 1083872212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA C185221) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C185221) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60518646) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 266536) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2024-05-09 |