| NPI | 1033372792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 64620) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101285548) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME125156) | |
| 208600000X Surgery (Licence: MI 4301092974) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2025-04-24 |