| NPI | 1689179632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A194766) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA 194766) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-08-13 |