| NPI | 1679896112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD473512) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A114005) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A114005) | |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2022-12-06 |