| NPI | 1306075064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX 47564) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101254938) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0109542063) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2022-06-03 |