| NPI | 1487681342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD468416) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 31416) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA C171504) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: RI MD19382) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2023-07-07 |