| NPI | 1700175874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD181942) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME126654) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A123187) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2021-04-12 |