| NPI | 1245582113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY TP450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC AF2435609) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2020-09-02 |