| NPI | 1083746671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 4301094023) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2004012738) |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2023-02-14 |