| NPI | 1639133200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 12834) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NV 12834) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WA MD00044060) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2024-09-17 |