| NPI | 1144601311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0066338) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 33598) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 13998A) | |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2022-03-18 |