| NPI | 1679716278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A117180) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT 184060) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C7-0004180) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2013030321) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2020-02-12 |