| NPI | 1154778959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 56541) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IN 01088292A) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 56541) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2018025916) | |
| Enumeration Date | 2016-05-21 |
| Last Update Date | 2023-09-21 |