| NPI | 1467681957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WA MD60775318) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD184316) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101250839) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101250839) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OR MD184316) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2024-08-29 |