| NPI | 1780985432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57452) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME 123702) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 57452) | |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2023-03-31 |