| NPI | 1942232129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301059831) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301059831) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301059831) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-05-25 |