| NPI | 1841534997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A123178) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A123178) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2023-11-17 |