| NPI | 1437296704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO CDRH.0046788) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 0444551) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 13455C) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 46788) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-04-21 |