| NPI | 1972584910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 50774) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2008020890) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2022-07-21 |