| NPI | 1023143302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 36829) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2003001822) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2003001822) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 36829) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2017-11-08 |