| NPI | 1760724199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD61003120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-37440) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-37440) | |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2020-06-30 |