| NPI | 1639463573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A123106) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125059767) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A123106) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2017-04-05 |