| NPI | 1699750679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200000751) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NC 200000751) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 200000751) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2022-02-03 |