| NPI | 1912953092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WV 25247) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: KY 33197) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-07-29 |