| NPI | 1104132497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR DO 168953) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP 60163812) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID O-0576) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR 162380) | |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2022-02-10 |