| NPI | 1164649448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NV 26591) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 26591) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT183631) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD435993) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2024-12-05 |