| NPI | 1760643290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD206802) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 102077) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD206802) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 053203) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2023-11-30 |