| NPI | 1124317474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0060419) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 67305) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A141398) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2021-03-15 |