| NPI | 1831456813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME153751) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 85266) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A149055) | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2024-04-03 |