| NPI | 1992078745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 57380) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A143530) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX R2168) | |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2023-03-24 |