| NPI | 1063441673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 63767) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2008014593) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2008014593) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2019-06-28 |