| NPI | 1114216462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A122716) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA A122716) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2021-12-20 |