| NPI | 1417480443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME160492) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 296412) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2023-03-24 |