| NPI | 1790762672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA 36775) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 33920) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 33920) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2024-05-02 |