| NPI | 1114364262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD61043907) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S0897) |
| 207R00000X Internal Medicine (Licence: PA MT-204538) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61043907) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2020-07-01 |