| NPI | 1467892133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 71406) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-46270) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 2017-02421) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2021-04-12 |