| NPI | 1659532174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M7725) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME143299) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M7725) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2022-05-24 |