| NPI | 1518183300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301088739) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-42441,) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 54786) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA MD-42441) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2023-08-07 |