| NPI | 1609219153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60926461) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD60926461) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60926461) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MT207508) | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2019-08-22 |