| NPI | 1750725651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 54505) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY IP1445) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY TP316) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2021-08-10 |