| NPI | 1164778056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME133999) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 24474) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 251215) | |
| Enumeration Date | 2012-07-28 |
| Last Update Date | 2018-09-10 |