NPI | 1205153418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60550670) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD179000) |
2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60550670) | |
Enumeration Date | 2010-04-27 |
Last Update Date | 2024-08-30 |