| NPI | 1750624979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: UT 9724223-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 9724223-1205) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 59934) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A175297) | |
| Enumeration Date | 2013-04-06 |
| Last Update Date | 2022-07-15 |