| NPI | 1427476704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD61045093) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61045093) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-00895) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2018-00895) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2020-10-08 |