| NPI | 1457453755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD22377) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD065652-L) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 205248-1) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00039093) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2022-02-01 |