| NPI | 1104144906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101260314) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD045211) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D83371) | |
| 208D00000X General Practice (Licence: NE 26326) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2022-11-30 |