| NPI | 1124394390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101264129) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101264129) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME143952) | |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2023-12-21 |