| NPI | 1780673616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 203290) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD09191) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 203290) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-10-06 |