| NPI | 1972572386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A42421) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-33689) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA 33689) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-12-30 |