| NPI | 1356537492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2020-00477) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101271217) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-00477) | |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2023-04-28 |