| NPI | 1184897654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301104427) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101248237) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301104427) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2024-09-17 |