| NPI | 1740630995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD17642) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 270807) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD17642) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2024-10-23 |