| NPI | 1194036574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 04-38788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125058810) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 28347) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: DC MD043000) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2021-06-02 |