| NPI | 1700839107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD151728) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G79869) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60175681) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AK 6912) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2018-05-15 |