| NPI | 1023012010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 047057) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-195) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: GA 047057) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2024-03-25 |