| NPI | 1356635957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME127715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL33586) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2021-09-23 |