| NPI | 1790076347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2015-02078) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101270954) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2015-02078) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2023-04-28 |