| NPI | 1003041930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME128154) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME128154) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301092712) | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2024-08-28 |