| NPI | 1174751051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2017-01411) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS13301) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL OS13301) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2022-01-25 |