| NPI | 1639598873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60707470) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60707470) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-15087) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID M-15087) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2020-07-01 |