| NPI | 1164683363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ND 12845) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 103870) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 51056) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2022-04-04 |