| NPI | 1760825350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 2015-00586) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 82236) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2015-00586) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: SC 82236) | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2019-10-17 |