| NPI | 1750465514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX U6895) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M9489) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: ID M9489) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-02-26 |