| NPI | 1083737563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VT 042.0016066) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35099703) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301106285) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301106285) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 081624) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2022-09-08 |