| NPI | 1700893047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 15363) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MS 15363) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MS 15363) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-03-02 |