| NPI | 1053601229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME130575) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN MD0000049416) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD00000049416) | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2020-10-08 |