| NPI | 1801278031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 84921) |
| Additional Taxonomies | 2085N0904X (Licence: GA 84921) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-10176) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2020-03-24 |