| NPI | 1457593279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60298562) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 61989 - 20) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60298562) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD172037) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD172037) | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2023-12-07 |