| NPI | 1316102080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2017004685) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120744) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2017004685) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2025-01-16 |