| NPI | 1396716437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME80004) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00046926) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00046926) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2022-08-02 |