| NPI | 1710364906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 67384) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 73588) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 275551) | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2021-11-02 |