| NPI | 1902058555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 81016) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60125332) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A99197) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81016-20) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60125332) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2023-07-13 |