| NPI | 1710334776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN MD0000061659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211100) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2023-09-20 |