| NPI | 1124380324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WA MD60854439) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60854439) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2018-09-11 |