| NPI | 1942641162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA 20A17397) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.062854) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.146705) | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2019-08-29 |