| NPI | 1912319989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0089297) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0089297) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI LP03111) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2020-08-03 |