| NPI | 1902896939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD09360) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD09360) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 205803) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2024-03-15 |