| NPI | 1912294182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 57199) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 57199) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2023-09-07 |