| NPI | 1568805406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 52672) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125064539) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP484) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2019-06-27 |