| NPI | 1376993063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A186634) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A186634) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-07-17 |