| NPI | 1417334921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0066174) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 13688A) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 2379) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2022-03-28 |