| NPI | 1265696140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2008-01633) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101270852) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2008-01633) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-04-27 |