| NPI | 1265812259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101276235) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC MD83975LL) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A147907) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2023-10-09 |