| NPI | 1629205158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2018036867) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD170809) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 15551) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A144116) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2022-09-12 |