| NPI | 1568849495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A162735) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A162735) |
| 208D00000X General Practice (Licence: CA A162735) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2024-06-26 |