| NPI | 1376856195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 65569) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125057552) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65569) | |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2023-08-09 |