| NPI | 1154563377 |
|---|---|
| Other Name | NONE NONE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63562-20) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 63562) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2021-01-29 |