| NPI | 1780772111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A103322) |
| Additional Taxonomies | 207UN0902X Nuclear Medicine Nuclear Imaging & Therapy (Licence: CA A103322) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A103322) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-12-07 |