| NPI | 1013357904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 92499) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2019-00150) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2019-00150) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-09-23 |