| NPI | 1205153418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60550670) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD179000) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60550670) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2025-01-07 |