| NPI | 1124472584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 275120) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MA 275120) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 275120) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2023-03-01 |