| NPI | 1477901080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 55778) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 55778) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2022-04-25 |