| NPI | 1114362068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 83886) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0062000) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0062000) | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2020-10-29 |