| NPI | 1831144005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA G68336) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G683360) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G68336) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2019-03-19 |