| NPI | 1972713733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD445568) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 237082) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD445568) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-09-28 |