| NPI | 1295832988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD18433) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00034481) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD18433) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00034481) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2013-11-27 |