| NPI | 1053397075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301501547) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0057378) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301501547) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 150900) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0057378) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2024-09-17 |