| NPI | 1780144634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 76598) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 05720) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-06-26 |