| NPI | 1033142740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 7157) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 21776) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD478603) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2022-07-12 |