| NPI | 1073824447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME135789) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269658) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 269658) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME135789) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2021-08-03 |