| NPI | 1568488971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G75671) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 16112) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G75671) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ND 16112) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2024-12-09 |