| NPI | 1205196607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60721597) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60721597) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD191346) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD191346) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2019-03-11 |