| NPI | 1659658292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0058686) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 35378) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 15739A) | |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2023-07-07 |