| NPI | 1033395165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 47479) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 47479) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A102468) | |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2021-09-24 |