| NPI | 1881810596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 8052A) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 6451) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WY 8052A) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-05-12 |