| NPI | 1558651091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA 20A15695) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 265778) |
| 208D00000X General Practice (Licence: TX P7030) | |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2017-09-28 |