| NPI | 1750527743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60025847) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60025847) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID M-12278) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12278) | |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2019-11-05 |