| NPI | 1154438646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101241948) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 19442) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 19442) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-01-20 |