| NPI | 1053799585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101273549) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101273549) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 287471) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 287471) | |
| Enumeration Date | 2015-05-17 |
| Last Update Date | 2024-06-03 |