| NPI | 1457770604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 60493) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME139656) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-03-09 |