| NPI | 1457301004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 8400A) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WY 8400-A) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-11-20 |