| NPI | 1134415177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A131897) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A131897) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT200580) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2024-04-09 |