| NPI | 1518917582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NV 17826) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120637) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A120637) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60182547) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2022-08-19 |