| NPI | 1679718209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MO 2020038097) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301088378) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2022-01-18 |