| NPI | 1124383237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME132960) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036.142157) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME132960) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2025-12-31 |