| NPI | 1780750257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA 20A 12771) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: HI DOS-1122) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2021-07-08 |