| NPI | 1053409086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME134376) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 7775) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ND 7775) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-07-14 |