| NPI | 1124212667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A76172) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD14763) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A76172) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2021-12-15 |