| NPI | 1528394715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81208-21) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 66538) |
| 363A00000X Physician Assistant (Licence: ME PA1395) | |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2023-06-19 |