| NPI | 1063613180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME115600) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD431204) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101245945) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2023-07-28 |