| NPI | 1033598792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 52741) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ R74915) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 52741) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2022-04-26 |